BV without symptoms: do you need treatment?

Author: Jessica Lloyd
Senior Vulvovaginal Specialist Naturopath | BHSc(N) | ISSVD, ISSWSH, BSSM, ATMS

Last reviewed: July 4, 2026

Yes, you can be told you have bacterial vaginosis (BV) when you feel completely fine, and for a lot of people that label may not mean anything is actually wrong. BV is usually diagnosed by scoring how much protective Lactobacillus bacteria do or do not show up on a sample, and pH levels.

The snag is that those scoring systems were built on what we know from ‘sick vaginas’, rather than a basis of what a healthy vagina looks like. A microbiome that is naturally low in Lactobacillus, and perfectly normal for that person, can get flagged as BV. And this is happening a lot, resulting in overtreating what may be a perfectly healthy vagina.

A 2023 analysis showed that computer tools built to diagnose BV misfire unevenly across ethnic groups.¹ So if your test says BV, but you have no symptoms, it is a fair question whether this can be diagnosed as BV, or whether the yardstick simply does not fit you.

Can you be diagnosed with BV without symptoms?

Easily. A great many people who meet the laboratory definition of BV have no symptoms at all, with no unusual discharge, no odour and no irritation.²

That happens because the standard tests do not measure how you feel. They measure the bacteria and the secondary symptoms of those species, like an elevated pH. The most common lab method, the Nugent score, counts the different bacterial shapes on a Gram-stained slide. It gives you a number from 0 to 10, where a low Lactobacillus reading pushes the score towards ‘BV’.³

The other common method, Amsel’s criteria, looks at things like discharge, vaginal pH and a whiff test.⁴ Both were developed decades ago on limited reference populations, and both treat a Lactobacillus-rich sample as the healthy default. This is where these tests no longer serve us as they stand; they’re too basic.

Is BV over-diagnosed?

For symptom-free people, BV is quite possibly not a problem for you. If the test’s idea of ‘normal’ is a microbiome dominated by Lactobacillus, then anyone whose normal state has less Lactobacillus can score as a problem even when nothing is wrong.

This matters because a ‘positive’ result rarely stays on paper. It tends to lead to antibiotics, worry, and repeat testing, none of which help someone who was never unwell in the first place. A BV diagnosis can also lead to shame and a sense that your vagina isn’t quite right, that it needs to be ‘fixed’.

This unfortunately fits into outdated beliefs about vaginas being ‘dirty’ or ‘smelly’, and feeds right into a problem we’re trying to solve, both as healthcare providers and people with vaginas: destigmatising vaginas. In the blessed enthusiasm to do better for vaginas, testing that points to only Lactobacillus-rich vaginal microbiomes being ‘good ones’ has misdirected healthcare providers.

None of this means BV is not real. It very much is, and when it causes symptoms it deserves proper treatment. The question is narrower, and worth asking: does a test result, on its own, mean a diagnosable, treatable health condition for you?

Here at My Vagina, we don’t believe BV on paper is very meaningful by itself. We treat every person based on their whole presentation, never only on a test result. If you don’t have symptoms, have never had symptoms, and you aren’t experiencing any issues, but your microbiome has a BV-like pattern? So what! Live on! Don’t go down an internet rabbit hole – the science isn’t there yet.

At My Vagina, we are vaginal microbiome specialist naturopaths and we know vaginas. Bacteria are just one element, and a diagnosis of BV must include symptoms of BV. (If you have burning, itching, dryness, tears or redness, you may be looking in the wrong direction.)

Why do BV diagnoses differ by ethnicity?

A Lactobacillus-dominant microbiome is not the universal normal it was once assumed to be. In a study of nearly 400 healthy, symptom-free participants, only around 60 per cent of the Black and Hispanic participants had a Lactobacillus-dominated microbiome.⁵ The rest had a more diverse mix of bacteria and a higher vaginal pH, and it appeared normal and healthy for them.

A larger study found the same pattern: even among women with no diagnosis and no symptoms, those of African ancestry were more likely to have a diverse, less Lactobacillus-heavy community than those of European ancestry.⁶

Now line that up against a scoring system that reads ‘less Lactobacillus‘ as ‘more likely BV’. You can see how a normal microbiome for one group gets scored as disease. When researchers tested machine-learning tools that diagnose BV from microbiome sequencing, the tools were most accurate for white women and least accurate for Asian women. They were also more likely to wrongly flag BV in Hispanic and Black women.¹

This is a critique of the measuring stick, not of any group of people. You can read more about how this plays out in whether Black women are really more prone to BV.

What this means for your vagina

Your vaginal microbiome is personal. A community that is lower in Lactobacillus can still be stable, comfortable and protective for you, and it does not automatically need correcting.

In our clinic, we read a result alongside your symptoms and your history rather than treating a test result on its own. Someone with a ‘positive’ score and no symptoms is a very different picture from someone who is miserable with discharge and odour, and the two do not get the same plan.

What we are most interested in is what tipped the balance if something has shifted, because understanding the why is what keeps real, symptomatic BV from coming back. A one-off score, on its own, rarely tells us that.

Why over-diagnosis matters

Treating a symptom-free ‘positive’ usually means a course of antibiotics. Antibiotics knock back disruptive bacteria, but they also disturb the protective ones, which can leave the microbiome less stable than before and set up a frustrating cycle of clearing and relapse.

There is a bigger cost too. If the reference populations behind our tests skew towards one group, the whole evidence base tilts with them, and everyone downstream inherits the same blind spot. Better, population-aware definitions of ‘normal’ would serve far more people well.

What ‘normal’ should mean

Normal is best understood as normal for the person in front of you: symptoms plus context, rather than a score in isolation. A comfortable, stable microbiome with a higher pH and less Lactobacillus can be perfectly healthy.

The field is slowly moving this way, towards diagnostics that account for the real diversity of healthy vaginas rather than a single reference template. Until that is standard, a symptoms-first reading is the safest way to interpret any BV result.

I got a home microbiome test and it said I have BV – what does it mean?

We know that there is no perfect vaginal microbiome; there are just vaginal microbiomes that give us clues as to what might be going on. If you have symptoms or are trying to get pregnant, a BV-pattern microbiome needs attention. If you don’t have symptoms and are not struggling with infertility, there is often no reason to worry.

The research does show that those with high protective Lactobacillus species are less prone to infections and sexually transmitted infections. But this doesn’t mean lactobacilli are the only good ones – it’s just the focus of research at the moment. And remember, even our most revered Lactobacillus, L. crispatus, can cause problems if there’s too much of it (see cytolytic vaginosis).

Practical takeaway

If you have a ‘BV-pattern’ result but no symptoms, it is worth asking a few questions before starting treatment:

Do I actually have symptoms, or was this picked up incidentally?
What method was used, and what is my vaginal pH?
Is my microbiome stable and comfortable for me, even if it is lower in Lactobacillus?
Is there a specific reason to treat right now, such as symptoms or an upcoming procedure?

Current guidelines reserve treatment mainly for people with symptoms. Routine treatment of symptom-free BV, including in pregnancy, is not recommended simply to prevent preterm birth.⁷ There are specific situations where a clinician may still choose to treat, such as before some gynaecological procedures, but that is a considered decision rather than an automatic one.

Confused and need advice? We can help

If you want to talk it over with a vulvovaginal specialist naturopath who works day in day out with people with BV, and everything else under the sun, book in. We know these tests, and our patients back to front, and are not bamboozled by anything. If you don’t need treatment, we’ll tell you so. If it’s not BV, despite the test, we’ll know how to help you.

Frequently asked questions

Do I need treatment for BV if I have no symptoms?

Usually not. Guidelines focus treatment on people with symptoms, and routine treatment of asymptomatic BV, including during pregnancy, is not generally recommended.^7,8 If you have no symptoms, it is reasonable to ask your clinician whether treatment is needed at all.

Can a BV test be wrong for me?

A test can be technically correct and still misleading. If your normal, healthy microbiome carries less Lactobacillus, a scoring system built around Lactobacillus dominance can read that as BV when nothing is actually wrong.^1,5

Is a non-Lactobacillus microbiome unhealthy?

Not necessarily. Research shows that many healthy, symptom-free women, particularly Black and Hispanic women, have diverse communities with less Lactobacillus and a higher pH, and these appear normal for them.^5,6 Diversity alone is not the same as disease.

Why might my result differ from a friend’s with the same bacteria?

Because the same reading can mean different things in different bodies. Symptoms, pH, history and your baseline microbiome all shape whether a result reflects a problem, which is why two people with similar samples can need very different advice.

What to do next

If you want to understand your own microbiome properly rather than rely on a single score, a comprehensive vaginal microbiome test gives you a fuller picture of what is actually there.

If you have symptoms, recurring BV, or a result you are not sure how to read, you can book an appointment. We will interpret it in the context of you rather than against a template. For the full background on the condition itself, see our guide to bacterial vaginosis.

This is general information, not a substitute for personalised medical advice.